John Swinton is professor of practical theology and pastoral care at the University of Aberdeen, Scotland, and founding director of the Centre for Spirituality, Health, and Disability at Aberdeen. In addition to taking a PhD in Divinity from the University of Aberdeen, he is a Registered Mental Health Nurse and has also served as a mental health chaplain. His other publications include Resurrecting the Person: Friendship and the Care of People with Mental Health Problems, Disability in the Christian Tradition: A Reader (ed. with Brian Brock) Living Well and Dying Faithfully: Christian Practices for End-of-Life Care, and Raging with Compassion: Pastoral Responses to the Problem of Evil. A quick perusal of these subtitles reveals that the author does not avoid difficult issues, even those for which no clear-cut answers are forthcoming.

The present work challenges readers to set the standard for “a truly Christian understanding of dementia and the development of authentically Christian modes of dementia care” (p. 6). He does not propose easy, feel good solutions, but rather, real growth rooted in the truth about God’s ways with his people and their illnesses.

Well-being, peace, health—what Scripture describes as shalom—has to do with the presence of a specific God in particular places who engages in personal relationships with unique individuals for formative purposes. Rather than alleviating anxiety and fear, the presence of such a God often brings on dissonance and psychological disequilibrium, but always for the purpose of the person’s greater well-being understood in redemptive and relational terms (pp. 7–8).

This view of well-being (shalom) provides a more accurate theological framework for the methodology we use to engage medical, psychological, and neurobiological input. He states, “We do not do theological reflection on demenita within a medical, psychological, or neurobiological context. . . . These disciplines are practiced within the context of creation and under the providential sovereignty of God” (p. 8). Against the trend, cognitive and the medical models must be consistent with sound theology.

How great is the challenge? Based on current growth patterns, by 2050 Alzheimer’s disease patients may triple in number. Pastors and other Christian leaders will look beyond astronomical healthcare costs to the more critical spiritual challenge: what will dementia mean for shepherding families and their churches? The financial repercussions for the families alone will be staggering. What is more, families overcome with a challenge that is beyond their comprehension will call upon pastors to help them understand and cope with an illness that may affect them in life-changing ways twenty-four and seven for many years. But that is not Swinton’s focus in this book. The author wants us to care for the person who suffers most, the dementia victim. What happens to us spiritually when we forget who we are and whose we are?

The absence of the cognitive self raises many critical questions for our theology and praxis (pp. 91–98). For example, what is the relationship between our personhood and our ability to understand? To find answers, the author eschews the medical model as the primary perspective on understanding and treating dementia. This includes calling into question the defectological approach to the illness. The central issue, says the author, is less treating the illness and more living with it from a theological perspective (pp. 9–13). For example, what does it mean that a dementia patient can no longer understand and believe theological realities, say for example, substitutionary atonement? This takes us directly to the role of the heart in personhood.

Dementia is a heart issue. A pastor’s commitment to God and service to his congregation is to provide shepherding care for the heart, which by biblical definition includes our thinking, feeling, and willing. Due to the complexity of the heart issues, dementia and other forms of mental illness may well be some of the most crucial challenges facing pastors, church workers and congregations. Heart questions include: What do we do with our virtual existence—i.e., what happens in our dreams and our memories? What do we do when our memories are gone? The author’s aim toward a theology of memory takes us one step closer to the realization of whose we are (p. 259). When in the course of mental illness we forget whose we are, the realities of our faith continue on long after we have forgotten them, for we “remain tightly held within the memories of God” (p. 15). If this is the spiritual reality for dementia victims, then what should be the response of pastors, churches, and caregivers? Not surprisingly, visitation hospitality, and gestures of love top the list (pp. 276–84).

The author calls us to treat the mentally ill, and their families and friends with understanding and compassion that is theologically informed. But what if we are those families? How might God minister to us? It is a moment of great blessing when a mentally ill person close to us speaks with near lucidity or does something with personal warmth that reminds us of who they are when the illness subsides, if even for a moment; but it is an exponentially more blessed moment when, amid the clouds of confusion, we realize that no matter how quiet and seemingly absent our loved one with dementia may be, they are safe in the arms of a loving Father who remembers them perfectly and will never let them go.

Because this study boldly explores an illness that is poorly understood, some readers may like the author’s questions more than his answers. But the exponential increase in dementia cases alone should stiffen our resolve to understand and minister to victims and their families. This reader highly recommends John Swinton’s study to all Christians, but especially pastors and other leaders.

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